University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) is naturally disappointed that, following a series of inspections carried out in 2018 the Care Quality Commission has rated the Trust as “Requires Improvement” after having been previously rated as “Good” under the previous inspection regime in 2016.
However, UHMBT Chief Executive Aaron Cummins said he welcomed the report and, in particular, the view of the CQC that colleagues across the Bay continue to provide caring and effective services to our patients despite significant pressures.
“The inspection was carried out between October and December 2018, with the unannounced, site-based element conducted for our urgent care and surgical services only in December. The observation of inspectors gives a fair reflection of how our organisation was performing in those areas over that period,” said Aaron.
“This is the first time the Trust has experienced the new CQC & NHS Improvement (NHS I) combined inspection regime, examining our hospital services, conducting a Well-Led Review and a Use of Resources Review (which highlights the Trust’s financial performance) simultaneously. This comprehensive assessment highlights both areas of good practice and areas we know we need to continue to improve.”
“These areas include improving the care and experience for our patients in our Emergency Departments (particularly when under pressure), improving our adherence to policies and procedures relating to documentation and checking equipment, continued improvement in recruiting additional staff and delivering improvements in our productivity and efficiency.”
“Despite the pressures the health system is under, we are all disappointed with some of the observations made as part of the inspection and I know we will all work hard to ensure we respond to the issues raised in the report quickly and that those improvements are sustained.”
Aaron also commented on some of the challenges the Trust is facing, particularly in relation to the Use of Resources assessment which NHS I rated as inadequate, contributing to the overall Trust rating.
“As a result of the current financial challenges (both local and national) our hospitals have not been sufficiently invested in over recent decades, resulting in buildings which are inefficient, overly costly to run and in some parts just not good enough for our patients or staff to have a consistently positive experience.
“Our colleagues make the very best of it – we’ve seen some phenomenal results of improvements in services delivered without any additional funding, done by working innovatively in partnership with our commissioners and other providers, such as GPs and community teams to reduce demand through schemes like our Patient Initiated Follow Up initiative, improved staffing through our nurse apprenticeship scheme or delivering our annual cost improvement plans each year; but to deliver further improvements and the efficiencies required over this next period we are looking to secure much needed capital investment.
“The Trust also has a number of challenges in improving its productivity and efficiency given its geography (covering 1,000 square miles) and the need to run three hospital sites to ensure the local population has the access it needs to essential health services. That said, there is now clear evidence of areas we can be more productive in – such as our operating theatres and outpatient clinics – which we are committed to delivering and improving services as a result.”
Aaron went on to commend the Trust’s colleagues: “I am proud to see that across the board, every area of the Trust has been rated as “Good” for the care provided for our patients. This has been the highest priority for the Trust on its improvement journey to this point and will continue to be as we seek to improve further and address the issues highlighted in the report. It was also great to see some areas of outstanding practice highlighted.”
These included:
- The introduction of a mobile ‘phone App for patients with arrhythmia, that enables them to record their cardiac rhythm as and when symptoms occurred; and a nurse led cardioversion service which frees up consultant time at the Cardiac Centre at Westmorland General Hospital
- Patients’ meals ordered electronically using a new system meaning people have more time to choose what they want to eat, and waste is reduced.
- In surgery the CQC observed positive, caring and kind interactions between staff and patients and staff caring for patients with compassion.
- Royal Lancaster Infirmary’s Ward 37 and Furness General Hospital’s Ward 9 have both achieved the end of life care Gold Standard Framework accreditation, in addition to Wards 23 (RLI) and the Acute Medical Unit at FGH
- Medical Care was well-led and rated as Outstanding. The Trust’s work with patients, staff, the public and local organisations to plan and manage care was particularly singled out. It was also noted that that the culture had changed beyond recognition over the last five years with high staff morale.
Turning to the comments made regarding the Urgent Treatment Centre at Westmorland General Hospital, Aaron said: “The Urgent Treatment Centre transferred to the management of the Trust on April 1 2018, and since then we have made a number of improvements which have enhanced the clinical care we provide.”
These include:
- Point of care testing, avoiding having to send blood samples to Lancaster for testing – speeding up the treatment for patients
- Investment in additional clinical staff
- Investment in x-ray equipment and radiology service operating times – allowing access to higher quality, faster images over a longer period of time.
- The staff appraisal and mandatory training target of 95% has now been achieved
- Patient Safety Incident reporting has increased and the UTC is now in our top ten departments for reporting incidents within its first year of being part of the Trust.
Aaron said: “The Trust is planning to spend the coming weeks discussing the final reports and the observations of inspectors with colleagues across our services and with partners across the Bay to ensure we are all sighted on the improvements we need to make. This is in addition to the actions already identified and completed or in progress following the initial feedback and the draft reports received.
“Our colleagues in Morecambe Bay have a track record of improvement by listening to feedback and using that feedback to work together to improve the services we provide for our patients. Our challenge is to ensure that those improvements are sustained, even in periods of pressure and I’m confident our teams will be able to do that again.”
The full Inspection reports for the Trust will be available from the CQC website.